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Organization
U.S.NAVY
Active
Organization
U.S.NAVY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCUS VANSICKLE M.S. (CLINICAL PSYCHOLOGY INTERN)
(757) 953-6741
Entity
Organization
Contact information
Practice address
470 MIDDLE ST, APT 220, PORTSMOUTH, VA 23704-2813
(757) 953-6741
Mailing address
470 MIDDLE ST, APT 220, PORTSMOUTH, VA 23704-2813
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
—
—
Other
Enumeration date
03/23/2016
Last updated
03/23/2016
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